Healthcare Provider Details

I. General information

NPI: 1285767772
Provider Name (Legal Business Name): PLATINUM MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2758 S KNOXVILLE WAY
DENVER CO
80227-3858
US

IV. Provider business mailing address

PO BOX 100130
DENVER CO
80250-0130
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-3788
  • Fax: 303-940-7773
Mailing address:
  • Phone: 303-777-3788
  • Fax: 303-777-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2006-2
License Number StateCO

VIII. Authorized Official

Name: MR. BRENT L CASS
Title or Position: OWNER
Credential:
Phone: 303-777-3788